Alisher Makkamdzhanovich Ismailbaev

Highlights We present the first case of successful simultaneous surgical treatment of a patient with breast cancer and a left atrial myxoma. The single-stage surgery, which included a right mastectomy and myxoma removal via a right thoracotomy, was justified by the high embolic risk and allowed for the complete elimination of both life-threatening conditions. The results demonstrate the feasibility of this approach with careful multidisciplinary patient selection and highlight the need for routine echocardiographic screening in the preoperative evaluation of cancer patients. Abstract Cardiovascular diseases remain the leading cause of death worldwide. Current data indicate a shift in the patient population, with malignant tumors increasingly common among them. Optimal surgical management for this comorbidity remains unclear, and the feasibility and safety of simultaneous radical treatment have been insufficiently studied. This clinical case demonstrates the feasibility and effectiveness of a simultaneous surgical approach after careful multidisciplinary patient selection. Simultaneous cardiac surgery and oncological intervention allowed for the resolution of both conditions and avoided the risks associated with delayed treatment of left atrial myxoma, particularly embolic complications.

Background. There was a trend towards valve-sparing techniques in aortic root surgery in recent decades. This approach can significantly improve the quality of life and do not require anticoagulation. There is a question on surgical strategy for patients with native aortic leaflets not suitable for reconstruction. We describe an alternative technique of aortic root replacement with certain advantages in mid-term period compared to standard Bio Bentall procedure. Material and methods. The study included 50 patients who underwent surgery for aortic root and ascending aorta lesions between 2014 and 2022. Mean follow-up was 31.0±17.9 months in the group «Russian conduit» and 39.2±22.7 months in the group 2 «BioBentall» (p=0.159). In the 1st group, patients (n=28) underwent a combined Bentall-De Bono procedure and aortic valve neocuspidization with autologous pericardium. In the 2nd group (n=22), surgery was performed using synthetic composite conduit containing biological aortic root stented prosthesis. Results. In the 1st group, there were no conversions to standard Bentall or BioBentall procedure. Cumulative freedom from MACE (delayed all-cause mortality, acute myocardial infarction, stroke, infective endocarditis) after 12, 24, and 48 months was similar (92.59±5.04% versus 100% (p=0.367), 88.7±6.1% versus 93.3±6.4% (p=0.534) and 88.7±6.1% versus 86.7±8.8% (p=0.864)). Freedom from redo surgeries throughout 48 months was 92.59±5.04% and 92.3±7.4%, respectively (p=0.734). Indexed effective orifice area in mid-term period was significantly larger in the 1st group (1.36±0.23 versus 0.93±0.1 cm2, p<0.01). Conclusion. Aortic root and ascending aortic replacement using Russian conduit technique demonstrates comparable results regarding freedom from redo surgeries compared to standard BioBentall technique and better hemodynamic parameters (mean pressure gradient and effective orifice area) in mid-term period. This approach may be successfully used for aortic root disease if reconstruction of native cusps is not possible.

Цель исследования: оценить результаты и провести сравнение методики аутоперикардиальной неокуспидизации аортального клапана при выполнении из мини-J стернотомии с торакоскопическим забором перикарда и полной срединной стернотомией. Материалы и методы: выполнен ретроспективный анализ результатов лечения 64 пациентов. 20 больным выполнена операция AVNeo из мини-J стернотомии с торакоскопическим забором перикарда (1 группа), 44 – классическая операция AVNeo (2 группа). Анализ коморбидной и сопутствующей кардиальной патологии не выявил разницы в исследуемых группах. В первой группе операция выполнялась с использованием искусственного кровообращения (ИК) по схеме «бедренная вена-бедренная артерия» у 14 (70%) больных, «бедренная вена-аорта» - 6 (30%) больных. Торакоскопический забор перикарда составлял 29,2±4,2 мин от постановки портов до полностью забранного перикарда и выполнялся на фоне искусственного кровообращения. Размер забранного перикарда не различался между двумя группами. Мини-J стернотомия выполнялась по III или IV межреберью, решение принималось на основании данных МСКТ. Результаты: анализ времени ИК и ишемии миокарда (ИМ) выявил достоверное увеличение длительности в группе мини-J стернотомии: в первой группе 175,5±11,6 мин и 102,5±7,8 мин, во второй – 114,4±40,6 мин и 84,4±19,9 мин (р>0,001 и p>0,001) соответственно. В первой группе отмечалось статистически значимое снижение объема кровопотери: 576±114,7 мл в I группе и 763,6±446,7 мл во II группе (р=0,027). Летальных исходов в первой группе не отмечено, во второй - 2 (4,5%) случая. При сравнении летальности между группами достоверная разница не получена (р=0,846). Длительность ИВЛ в послеоперационном периоде достоверно меньше в первой группе 2,85±2,3 часов, чем во второй – 5,18±3,9 часов (р>0,001). Интенсивность болевого синдрома по шкале ВАШ показала достоверное снижение в I группе (р>0,001). При оценке длительности пребывания в стационаре после операции отмечается достоверное уменьшение количества койко-дней в I группе (7,1±3 суток) против (13,9±5,5 суток) II группы (р>0,001). По результатам оценки эффективности операции не получено достоверной разницы между двумя группами. Выводы: торакоскопический забор перикарда позволяет применить преимущества миниинвазивного доступа к операции AVNeo. Методика миниинвазивной аутоперикардиальной неокуспидизации аортального клапана является безопасной и эффективной методикой.

Introduction. Some patients with aortic valve (AV) disease have small aortic annulus. This anatomical feature can lead to prosthesis-patient mismatch after AV replacement. Objective. To improve postoperative outcomes in patients with AV disease and small aortic annulus. Material and methods. We retrospectively analyzed 77 patients with small aortic annulus divided into 2 groups: group 1 (n=49) — autopericardial neocuspidization (AVNeo) of the aortic valve, group 2 (n=28) — aortic root enlargement and standard aortic valve replacement using mechanical or biological prostheses. Analysis of comorbidities found no differences between groups. Results. In-hospital mortality was similar (2.1% (n=1) and 7.1% (n=2), respectively, p=0.321). Survival rate was 96% and 74%, respectively (p=0.04), cumulative freedom from MACE — 95% and 53% (p=0.03), freedom from redo surgery — 95% and 80%, respectively (p=0.381). Duration of cardiopulmonary bypass and myocardial ischemia was similar: 113.84±36.03 vs 116.61±25.01 min, (p=0.71); 86.74±23.19 vs 91.04±22.71 min, respectively (p=0.404). The incidence of permanent pacemaker implantations was significantly higher in group 2: 6 (21.4%) vs 2 (4.1%) cases (p=0.039). In early postoperative period, transvalvular peak blood flow velocity (p<0.01) and pressure gradient (p<0.01) significantly decreased in the 1st group compared to the 2nd group. Mean transvalvular pressure gradient in mid-term period was significantly lower in the AVNeo group (p=0.001). Conclusion. AVNeo in patients with small annulus demonstrates the advantages over aortic root enlargement regarding mid-term results due to better hemodynamic parameters after surgery.

Objective. To analyze 3-year outcomes after Ozaki procedure. Material and methods. A retrospective multiple-center study included 251 patients with aortic valve disease between January 2017 and February 2020. Results. The main indication for surgery was severe aortic stenosis in 230 (91.6%) cases, bicuspid aortic valve in 88 (35%) cases, aortic regurgitation (AR) in 21 (8.4%) cases and infective endocarditis (IE) in 12 (4.8%) cases. The sample included 116 (46.2%) men and 135 (53.8%) women (mean age 66 (60—70) years). There were no conversions of the Ozaki procedure to aortic valve replacement with biological or mechanical prostheses. Xenopericardium was used in 7 cases due to redo surgeries. Combined interventions were performed in 103 (42.2%) patients. In-hospital mortality was 1.2%. Two (0.8%) patients underwent redo sternotomy for bleeding. Follow-up was completed in all patients (median period 24 (17—32) months). Three-year survival and freedom from redo surgeries were 90.6% and 94.6%, respectively. Postoperative echocardiography revealed mean pressure gradient 6 mm Hg. AR ≥2 was detected in 13 (8.3%) patients in 22.6±9.9 months after surgery. Baseline IE (p=0.04) and AR ≥2 (p=0.006) at discharge are significant predictors of aortic valve dysfunction after Ozaki surgery. Conclusion. The Ozaki procedure in patients with aortic valve disease has favorable immediate results regarding in-hospital mortality and postoperative morbidity, as well as optimal intermediate results regarding survival, freedom from redo surgeries and hemodynamic parameters. Further monitoring of patients is necessary to assess the long-term results after this procedure.

Highlights: The mid-term echocardiographic outcomes of aortic valve replacement with autologous pericardium presented in the literature are limited to the basic parameters related to transvalvular hemodynamics; This study is the first in the world to conduct a comprehensive detailed analysis of echocardiographic parameters after neocuspidization using autologous pericardium, both in comparison with standard replacement and between different age populations; Aortic valve neocuspidization using autologous pericardium adult patients of any age group in comparison with mechanical replacement in the mid-term period is characterized by a higher effective orifice area, significant dynamics of left ventricular myocardial mass regression, low potential for the preservation of significant mitral regurgitation.  AbstractAim. To analyze echocardiographic parameters after aortic valve replacement using autologous pericardium in various age groups of the adult population.Methods. The multicenter prospective non-randomized cross-controlled study included 71 patients evaluated after surgical correction of aortic valve (AV) stenosis in the mid-term. The population (n = 71) is divided into the following populations: 1 – AVNeo Y (n = 24) – patients aged 19 to 50 years who underwent neocuspidization using autologous pericardium; 2 – AVNeo A (n = 23) – patients aged 51 to 79 years who underwent neocuspidization using autologous pericardium; Group 3 – AVR (n = 24) are patients aged 26 to 50 years who have undergone mechanical replacement. The end points were as follows: index of effective orifice area (EOA), left ventricular mass index (LVMI), peak gradient on AV, peak velocity on AV, pulmonary hypertension (PH), frequency of significant mitral regurgitation (MR), end-diastolic LV volume, LV ejection fraction.Results. In the group 3 (AVR), the lowest EOA index was noted in comparison with the group 1 (AVNeo Y) (p < 0.01) and the group 2 (AVNeo A) (p = 0.02). Significant dynamics of LVMI decrease was observed in groups 1 (AVNeo Y) (p < 0.01) and 2 (AVNeo A) (p < 0.01). In the group 3 (AVR), there was also a decrease in the LVMI in the mid-term, but it went beyond the limits of reliability (p = 0.07). The peak gradient between the groups in the mid-term period was 8.5±2.7 mmHg in the group 1 (AVNeo Y), 8.5±2.6 mmHg in the group 2 (AVNeo A) and 15.6±4.1 mmHg in the group 3 (AVR) (p < 0.01). With respect to significant MR, there was a significant increase in its frequency in the group 3 (AVR) in comparison with other groups (p < 0.01). Moreover, in the group 3 (AVR), a more frequent occurrence of PH was noted in comparison with the group 1 (AVNeo Y) (p < 0.01).Conclusions. AV mechanical replacement in young patients in comparison with neocuspidization using autologous pericardium in adult patients of any age in the mid-term period is characterized by a lower EOA index, the absence of significant dynamics of LVMI regression, a higher peak transvalvular gradient, and a high potential to preserve significant MR and PH.

Highlights Valve replacements using mechanical prostheses are not inferior, and sometimes even advantageous to bioprostheses in terms of transvalvular hemodynamics and left ventricle reverse remodeling; During the average follow-up period, a significantly lower average pressure gradient and a higher effective opening area were recorded in the group undergoing neocuspidization with autologous pericardium compared to other types of implants; Despite the obvious hemodynamic advantages of transcatheter aortic valve replacement, the midterm follow-up has revealed significant residual aortic regurgitation, which is highly undesirable.  AbstractCurrently, there are not enough data on the comparative analysis of echocardiographic outcomes, especially in regards to the state of the left ventricle in the long term after different aortic valve interventions. In this review, we present up-to-date literature data (publications published over 20 years) concerning echocardiographic outcomes after different aortic valve replacements. For the search of publications, the authors used international databases such as Scopus, Web of Science, Pubmed and Cochrane. The search keywords were: “aortic valve surgery”, “long-term period”, “echocardiographic outcomes”, “quality of life”. The analysis includes only comparative randomized, prospective or retrospective studies. A comparison between mechanical and biological prostheses has demonstrated that mechanical valves, in addition to displaying higher durability, can be advantageous in certain situations to bioprostheses in relation to transvalvular hemodynamics and reverse left ventricle remodeling. Regarding the comparison of stentless and stented bioprostheses with respect to peak transvalvular gradients and the effective orifice area, an obvious advantage was observed in the stentless bioprosthesis group. The majority of randomized clinical trials have showed great hemodynamic advantages of the Ross procedure in comparison with other types of aortic valve replacement, and an increase in the number of participants (due to future trials) may demonstrate even greater statistical significance. We have found only one publication that presents data on the comparison of the mid-term hemodynamic outcomes of neocuspidization of the aortic valve using autologous pericardium with other types of interventions. With an average follow-up period of 426±270 days, a significantly lower average pressure gradient and a higher effective orifice area were recorded in the neocuspidization group. Despite hemodynamic benefits of transcatheter aortic valve replacement in the mid-term period after surgery, the results of postoperative monitoring show significant residual aortic regurgitation, which is highly undesirable.

HighlightsThe article presents the latest data on the techniques of implantation of the mitral homograft in the tricuspid position, and identifies groups of patients who are best suited for this method. Moreover, the article describes the evolution of this type of replacement, and highlights that many surgical techniques, although justified, require further study to show demonstrate their advantages. AbstractDespite the general trend in cardiac surgery towards valve-preserving interventions, valve replacements remain relevant, and the search for the perfect prosthetic valve continues. Many believe that tricuspid valve replacement using a mitral homograft can be the method of choice in certain situations. The analysis of the studies found in the PubMed database led the authors to the following conclusions: most of the data on the use of this technique in patients with infective endocarditis (IE), other indications are congenital heart disease (CHD) and rheumatic heart disease. Patients with IE who have undergone tricuspid valve replacement using a mitral homograft have good medium-term prospects, and respond well to medical treatment of recurrent IE. The mitral homograft in the tricuspid position remains intact even after prosthetic endocarditis. In this regard, it is possible to perform reconstructive intervention in case of prosthetic valve dysfunction without the need for repeated replacement. Such interventions are relevant for patients with growing heart for whom annuloplasty at the first stage of surgery is undesirable. Moreover, it is also cost-effective due to the high cost and low availability of homografts. The possibility of repeated tricuspid valve-in-valve replacement is important for patients who may not survive open surgery. To date, there are not enough long-term and short-term data on using a mitral homograft for tricuspid valve replacement, however, it can be assumed that the results of this technique will be positive provided that the appropriate implantation technique and strict patient selection are ensured. Many authors have come to the conclusion that the optimal homograft implantation technique includes sewing of the graft`s papillary muscles into the wall of the myocardium of the right ventricle (RV), fixating them on the outer surface of the RV, anatomical positioning of the homograft (anterior leaflet faces towards the IVS), and the use of an annuloplasty ring.

Objective. Assessment of organizational and clinical aspects of acute coronary syndrome combined with a new coronavirus infection (SARS- CoV-2).Materials and methods. This is a retrospective study where 60 patients were divided into the following groups: group 1 patients with acute coronary syndrome (ACS) and a new coronavirus infection hospitalized in the «red» zone after infection was detected at the prehospital stage (n=29); group 2 - uninfected coronavirus infection patients with ACS (n=31). The primary points were mortality in the hospital and the average time (up to 2 months) after ACS, the incidence of acute heart failure, the incidence of ACS with ST segment elevation, the frequency of acute coronary artery occlusions.Results. The analysis of hospital mortality revealed its higher level in the ACS group and COVID-19 (group 1) (p=0.009). Mortality within 2 months was also higher in group 1 (p=0.017). The groups did not differ in the number of patients with ACS and ST segment elevation and acute coronary artery occlusions. Analysis of the incidence of OSN at admission revealed a statistically significant difference (p=0.05) in group 2 (n=12, 38.7%) compared with group 1 (n=5, 17.2%).Conclusions. Patients with ACS and COVID-19 are characterized by a higher initial severity, a tendency to develop ACS with ST segment elevation, high rates of hospital and 60-day mortality. Separating the flows of infected and uninfected patients makes it possible to improve the epidemiological situation in non-infectious hospitals, however, it leads to a delay in hospitalization of patients with ACS and COVID-19, which potentially increases the risk of fatal complications in this cohort.